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Low Testosterone in Males

Last updated May 7, 2018

Approved by: Maulik P. Purohit MD, MPH

Low Male Testosterone is a condition in which the body does not produce adequate levels of testosterone, a hormone essential to the development of male sex organs and secondary male sex characteristics.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Andropause
  • Low Male Testosterone
  • Male Hypogonadism

What is Low Testosterone in Males? (Definition/Background Information)

  • Low Male Testosterone is a condition in which the body does not produce adequate levels of testosterone, a hormone essential to the development of male sex organs and secondary male sex characteristics
  • Testosterone levels can be low from birth (congenital causes) or may become low later in life, due to factors, such as injury, infection, aging, genetics, or other health problems
  • In most cases of Low Male Testosterone, the problem lies either with the functioning of the hypothalamus (an essential hormone-producing region of the brain), or due to low hormone production in the testis (the testosterone-producing organ)
  • In normal cases, the hypothalamus is stimulated to produce luteinizing hormone (LH) and follicular-stimulating hormone (FSH). LH and FSH, in turn, stimulate testosterone production. When factors such as injury, infection, or other health issues arise that affect the hypothalamus, there is a disruption of brain signals to other body organs, including the testes leading to reduced levels of testosterone
  • Also, when the testes are damaged, they are unable to properly interpret brain signals to produce testosterone, leading to low/reduced levels of testosterone production
  • In many cases, the condition of Low Male Testosterone can be treated to reduce the signs and symptoms associated with it. Most males are able to function normally and lead normal lives with proper treatment

Who gets Low Testosterone in Males? (Age and Sex Distribution)

  • Males of all ages are at risk of developing the condition of low testosterone levels
  • Low Testosterone in Males can exist from birth or develop later in life. It is most prevalent, however, in older men, as the risk of developing the condition, increases with age
  • The disorder can affect men of all racial and ethnic groups

What are the Risk Factors for Low Testosterone in Males? (Predisposing Factors)

Risk factors of Low Male Testosterone include:

  • Genetic disorder that affects the brain or organ development (such as Kallman syndrome, Klinefelter syndrome)
  • Undescended testicle (also called cryptorchidism)
  • Testicle injury, infection, testicular cancer
  • HIV/AIDS infection
  • Chemotherapy or radiation therapy
  • Hemochromatosis (a disorder that causes body to absorb and store iron in large quantities)
  • Family history of low testosterone
  • Steroid use (like performance-enhancing steroids)
  • Obesity

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Low Testosterone in Males? (Etiology)

Low Male Testosterone (also known as Male Hypogonadism) is usually caused by the improper functioning of either of the two organs, the hypothalamus or the testes.

When there is damage to the testis, primary hypogonadism is diagnosed. In this form, the testes are unable to produce adequate testosterone, which may be caused by a variety of reasons including:

  • Genetic disorders that impact testes formation, like Klinefelter syndrome (in which more than one X chromosome is present in males)
  • Testicle infections that cause damage (like mumps, orchitis)
  • Undescended testicles
  • Radiation or chemotherapy damage from cancer treatment 
  • Autoimmune disorders
  • Surgery

When the cause of low testosterone is due to malfunctioning of the hypothalamus, central hypogonadism is diagnosed. This may be caused by:

  • Genetic disorders that impact brain formation, like Kallmann syndrome (that causes abnormal hypothalamus formation)
  • Inflammatory diseases
  • HIV/AIDS infections
  • Obesity
  • Medications, including steroids, opiates
  • Tumors
  • Brain trauma  

What are the Signs and Symptoms of Low Testosterone in Males?

Signs and symptoms of Low Male Testosterone include:

At birth:

  • Ambiguous genitals
  • Female genitals
  • Underdeveloped male genitals

At adolescence:

  • Decreased muscle mass
  • Decreased bone mass
  • High-pitched voice
  • Lack of body hair
  • Impaired penis and testicle growth
  • Development of breasts

At adulthood:

  • Erectile dysfunction
  • Infertility
  • Fatigue
  • Hot flashes
  • Decreased sex-drive

How is Low Testosterone in Males Diagnosed?

A diagnosis of Low Male Testosterone is most commonly done through a medical examination. If the physician notes slow sexual development or underdeveloped sexual organs, then ‘low testosterone’ is the likely problem. Other common signs that are indicative include: Very little-to-less pubic or body hair, low muscle & bone mass and small testes.

  • To confirm this diagnosis, blood tests that measure blood testosterone levels are conducted. It is recommended that blood tests be done in the morning, which is when testosterone levels are at their highest
  • In order to determine if the cause of low testosterone is due to organ or hypothalamus abnormalities, other tests are done. These tests include:
    • Semen analysis
    • Pituitary and hypothalamus imaging
    • Genetic testing
    • Testicular biopsy (collection of tissue from the testicles for analysis)
    • MRI or CT scan of brain 

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Low Testosterone in Males?

The types of complications that arise from Low Male Testosterone vary, and they depend on the age at onset of the condition:

  • If low levels of testosterone are present from birth, the child may suffer from ambiguous genitalia or development of female genitals. This can cause health problems, as well as emotional suffering, as the child grows older
  • If low testosterone is noted during adolescence, penis and testicle growth may be impaired; breast development and lack of body hair growth, may occur. The biggest complication arising from these symptoms are emotional difficulties
  • Into adulthood, infertility, erectile dysfunction, and decreased sex-drive may occur. This impacts lifestyle and can lead to emotional issues
  • Other health problems including osteoporosis (decreased bone growth and bone strength) may also develop

How is Low Testosterone in Males Treated?

  • Hormone replacement therapy is the most commonly recommended treatment for Low Male Testosterone levels. This can restore sexual functioning, improve muscle mass, and reduce bone loss. Men may also experience increases in energy levels and sexual desire
  • In most cases, testosterone or pituitary hormones are replaced through this therapy option
  • Hormone replacement can occur through a variety of methods, including injections, patches, gels, or administered orally

How can Low Testosterone in Males be Prevented?

  • It is difficult to prevent Low Testosterone in Males. Considering the variety of factors that can cause the hormonal condition, there is little that can be done currently, in terms of prevention
  • It is important to maintain a healthy diet and lifestyle and exercise regularly, to try and reduce your risk of developing testosterone problems

What is the Prognosis of Low Testosterone in Males? (Outcomes/Resolutions)

  • With prompt diagnosis and proper treatment most males with low testosterone levels can go about their regular/normal lives, with reduced symptoms
  • Without treatment, the medical problems could become worse as time passes. This may also cause other health problems to arise

Additional and Relevant Useful Information for Low Testosterone in Males:

Menopause is a condition that occurs in females where menstruation permanently ends. Females experience menopause when their ovaries stop producing estrogen and progesterone. This results in the conclusion of menstrual periods.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Nov. 20, 2013
Last updated: May 7, 2018